'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Check testosterone in all men with ED, new guidance advises

New guidelineshave called for GPs to routinely test all patients with erectile dysfunction, to establish whether the condition is caused by low testosterone levels.

The guidance, from the British Society for Sexual Medicine (BSSM), highlights that testosterone deficiency syndrome (TDS) is a treatable cause of erectile dysfunction.

Low testosterone levels are associated with reduced sexual health, loss of libido and lack of responsiveness to the PDE5 inhibitor drugs that treat erectile dysfunction. Around 1 in 3 men with erectily dysfunction also have TDS.

TDS, once diagnosed by means of a test of serum testosterone levels, can be treated with testosterone therapy.

Professor Pierre-Marc Bouloux, consultant in endocrinology and diabetes at the Royal Free Hampstead NHS Trust, London, said: ‘Testosterone deficiency syndrome is more common than GPs realise and it is important that it is recognised as a potential cause of erectile dysfunction.

‘These guidelines have initiated a long overdue call to action for GPs to start checking testosterone levels in all their erectile dysfunction patients.'

Dr David Edwards, GP with an interest in sexual dysfunction and secretary of the BSSM, said: ‘Testosterone deficiency syndrome is an easily treated cause of erectile dysfunction and not enough GPs are diagnosing the problem.

‘All patients presenting with erectile dysfunction must have serum testosterone levels checked, especially as their response to PDE5 inhibitors may be compromised.'

The guidelines are published this week in the Journal of Sexual Medicine.